british politics

I had a psych appointment at 12.30. Having crash landed into the NHS Mental Health Trust 13 years ago, today came the novelty of having to produce my passport, a recent bank statement and a fully completed “Pre-Attendance Form.” To discuss these documents at the start of a health assessment, then having to wait as they were photocopied at the end.

Immigration and public services are hot button issues right now, perhaps in ways they haven’t been since the 1980s. As Chris Addison noted, we accidentally elected a Conservative government four years; and the rise of UKIP has ratcheted up every tension. Still, I’ve been in the goddamn system long enough to prove my entitlement status. And, crucially, personally, I don’t consider the PAF in the spirit of socialised medicine.

NHS funding principally comes from taxation. I am a tax payer. That illegal immigrants may be using the service has never pissed on my pancakes. Individual health benefits everyone. If you have to drive without a license, its better you don’t fall into a diabetic coma at an intersection. I’ll concede that our borders need policing, that immigration must be handled responsibly, but I can’t help but shudder when I read how information from the PAF can be passed to the UK Border Agency ‘…if it is deemed necessary by the trust.’ Patient information. I had to answer questions about the number of residents in my house. Number of hours I work a week. 13 years. The first time in 13 goddamn years.

Please note non presentation of the above documentation on the first appointment could delay your assessment and subsequent treatment.

I’ve contacted these people because I want to keep my options open, given my recent spikes in hypomania and bouts of whip-spin paranoia. I am relatively stable right now, so a delay wouldn’t do much harm. But I have to compare my current state of mind to Me at 17. Late teens, consistent self-injury, potent depression culminating in a dramatic suicide attempt that – while not taking my life – could have left me paralysed. My 17 year old self couldn’t wait. It was my mother stressing this that actually got me into the clinic. The trust wanted to release me back into the wild.

Everything about the NHS, particularly the mental health sector, just feels paradoxical and contrary and kind of frustrated. Even Dr Sri; the very paradigm of a dedicated, intelligent, sympathetic professional bemoaned this. That he couldn’t do more for his patients. I refuse to accept that the NHS, or socialised medicine of any stripe, is inherently doomed to fail. Any ill fate comes from incompetence and mis-management, hackneyed bureaucracy and financial derangement. Manipulation and greed.

A recent case centres on a Basildon man forced to pay £2000 per week to treat his brain tumours. ‘Avastin is not licensed by the manufacturer for treatment of brain cancers in England’, an NHS teeth-piece explained. As noted in the article, cosmetic surgery and gastric bands are readily available on the NHS. I don’t really object to these, but clearly we’re forced to come down on either side of this issue. That force is economic.

The devil is always in the unnerving machinations when it comes to Big Pharma. In the excellent Cracked.com article 5 Terrible Secrets Big Drug Companies Don’t Want You to Know, writer Andrew Munro recalls the curious history of Sarafem. Marketed by drug firm Eli Lilly as a treatment for premenstrual dysphoric disorder (PMDD), Sarafem was a breakthrough in the fight against an ‘…exaggerated form of PMT.’ The typical symptoms of PMDD (fatigue, emotional instability, anxiety, disinterest in daily activities and difficulty concentrating) may be familiar to those receiving treatment for depression, which is handy, considering Sarafem is Prozac by another name. And a pretty colour palette.

Munro: ‘…by releasing a new drug identical to Prozac, Eli Lilly managed to extend their patent by a few years, allowing the price of Prozac to remain nice and high.’ This is what we have to contend with, as “service users”. The administrative locust horde, frenzied by persistent interference from mandarins, transient politicians and “business managers”; whilst being undermined by low-quoting contractors and manipulated by opportunist corporations who’s spreadsheets can determine who lives and who dies. Now we can add crossing guards to the roll call.

I fear for the NHS. For all my criticisms, for all my ideological stances against the dominant psychiatric models, I have to accept that it has helped keep me alive. Given the sense of disquiet and violation I feel after today’s meeting, I fear for others like me, especially those younger than me, who now have another swamp of uncertainty to wade through. We have an increasing Eastern European presence in this part of the world. Whole new generations who may need access to mental health services. Young people, older people who’s misery, fear, torment, doubt, self-loathing, anger – the whole bloody rainbow of psychiatric crises – may now be compounded by a fear of incriminating themselves or those they love.

“That’s inhuman!” a colleague of mine exclaimed last week. I’m consistently waking around 5.30am, which is abhorrent to most people. Further down the spiral – it skips, morning to morning, between 5.23 and 5.25. An unnerving recurrence; a triumph of chaos theory over mundanity.

I like having more of the day to play with. Early breakfast, cup of tea, washed with clean teeth before the paper arrives. Ready for a productive day, beginning with at least two hours of Warframe. Youtube on in the background, playing old episodes of Mock the Week and Have I Got News for You. My wellspring of political thought.

When I’m not killing Grineer, I’d like to be doing this. Typing. Hopefully something worth reading, by myself and by others. Activism is becoming a significant part of my Me, but a consistent failing, as my untrained eye can observe, is when one occupies a single issue, denying the prismatic facets of simply being here.

I finished Emma Forrest’s Your Voice in my Head. A memoir of mental illness and recovery which doesn’t entrench itself in the minutiae of mental illness and recovery. Love and sex and family and animals and opportunity and self harm and suicide. The tapestry. Take a tapestry and focus upon several threads. If you’ve lived the way I have these past 30 years, you’ll know how well this works.

Read, write, repeat. I need, I want, to fall in love with words again. Actually this is deceitful – I want to love the words of others, which is why (at the start of 4.0) these authors are wellsprings of optimism.

30 years. 6.5 hours. What’s inhuman is not the time you’ve lost. There’s no inherent glory in any time you might have gained. Just don’t frustrate the promise of every second you collapse into.

If you’re suspicious of my motivations or judgement, I won’t hold it against you. Suicide attempts: mine unsuccessful, a father and a best friend no longer with us. At times my appreciation of an end was rose tinted – red of many kinds; a fuck you, a bonfire, an end to misery and fear, a deluded sense of charity to those I love.

I have to imagine how I’d feel about assisted suicide had things been different. I can’t be objective of course, but I believe I would hold the same position. Absolute possession of yourself and your life. My zero principle. Assisted suicides happen all the time, but I will concede that society has a right to protect itself. If assisted suicide becomes law in this country, it needs to be powerfully legislated. The controls have to neutronium grade, because abuse can and will happen.

Our old friend Thomas Szasz defended a person’s right to commit suicide. A liberal interpretation of human freedoms far in excess of anything bought before the Lords. Defended but not recommended – Szasz asserted that society lacked the moral right to interfere. ‘The result is a far-reaching infantilization and dehumanization of the suicidal person’. I can’t say I agree with him entirely, but broadly his points carry a lot of weight.

A level of competence must be evident. An exploration and knowledge of all options present and correct. Strictly defined legal processes, focussed not only on the individual and the action; but their possessions and legacies. All of these and many factors I’m too ill informed enough to even conceived of.

This is a minefield. Everyone will have an opinion and most of us won’t be qualified, for one reason or another, to fully comprehend the complexities of the issue. What’s encouraging however, is that the debate is taking place. People are suffering but not dying, though arguably not living either. I have no right to decide whether another person’s life is worth living or not. Its not unreasonable to question societies’ right as well.

In England, as of April 1st 2014, the NHS prescription charge stood at £8.05 per item. My repeat script requires coverage for both lithium carbonate (Priadel) at 800mg per day and lamotrigine (Lamictal) at 200mg twice daily . Were it not for my Medical Exemption certificate I would be paying £16 per month for medication that has, arguably, kept me alive.

Curiously I’ve managed a kind of “3 for 2” deal – Lamictal was prescribed for my idiopathic epilepsy, but its often used to alleviate depressive episodes in bipolar affective “disorder”, for which I was prescribed Priadel many years after. In November 2012 Dr Sri wrote a script for an atypical antipsychotic, olanzapine. A third medication addressing the white noise paranoia hissing away in the background, and ultimately a fridge too far in terms of my pharmacotherapy.

That I declined to take the olanzapine is besides the point. My circumstances permit the expense of £24.15 a month, but chronic means chronic, and circumstances can change. I am grateful, I am humbled by the generosity of the British tax payer and, speaking as one of them; I am happy, I am proud that my taxes help provide coverage for others in turn.

But as noble as the National Health Service is, contemplation of its future is likely promote instances of immeasurable terror. I no longer see bipolarism as a disorder, a disease. Living with this disposition, and all of its nuances, I’m inclined to consider it more an immune response than a disease entity in its own right. Dr Sri and I disagree on this point, but his decency and intellect enabled us to work together for my benefit. A calm, reasonable and charismatic man; but also one who – in a stark moment I will never forget – expressed a morbid despair at the limits of the care he was able to provide.

I won’t calculate how many prescriptions that amount would cover. One wonders what Nye Bevan would make of the NHS today, especially since his party, of which I’m a lifelong supporter, has steered it into so many walls. One expects a Conservative government to screw with the NHS, but its legacy as a force for the greater good is a jewel in Labour’s crown. Tony Blair’s grasp on the NHS suffered a snowballing degeneration, much like his sanity; and after Gordon’s reign of inanity the duty of care and restoration resides with David Cameron.

The NHS is in crisis. Depressingly, I cannot remember a time when it wasn’t in crisis. However I can also recall the many acts of dedication and professionalism and kindness that have shined through when it mattered the most. The rapid response of paramedics last week when I suffered one of my worst seizures. The home visits and mobility improvements my grandmother enjoyed. The extraordinary palliative care my aunt received last year as she was consumed by cancerous tumours.

There are practical benefits to the RCN’s considerations. For my part, however, I cannot escape the feeling that such a notion will afflict those the vision of a National Health Service best serves. Those of the most limited means, the poor, the disadvantaged, the disregarded. Those with mental health concerns can require a greater percentage of visits to the GP often long before any diagnosis is forthcoming.